Narrative Review of Effects of Glucagon-Like Peptide-1 Receptor Agonists on Bone Health in People Living with Obesity

Nov 24, 2023Calcified tissue international

Effects of Glucagon-Like Peptide-1 Medicines on Bone Health in People with Obesity

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Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1Ras) may influence bone health in people living with obesity.

Significant weight loss from caloric restriction and bariatric surgery is associated with accelerated bone turnover and bone loss.
Bariatric surgery, particularly malabsorptive types, leads to deterioration in bone microarchitecture and strength, increasing fracture risk.
Liraglutide appears to positively affect bone material properties in rodent models despite significant weight loss.
Positive effects on bone mineral density and microarchitecture from liraglutide were observed at concentrations higher than those approved for human use.
Current evidence on the effects of GLP-1Ras on bone health in people living with obesity is limited and primarily derived from studies involving diabetic patients.

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Glucagon-like peptide-1 Receptor agonists (GLP-1Ras) such as liraglutide and semaglutide have been recently approved as medications for chronic weight management in people living with obesity (PwO); GLP-1 may enhance bone metabolism and improve bone quality. However, the effects of GLP-1Ras on skeletal health remain to be determined and that's the purpose of this narrative review. Nevertheless, bone consequences of intentional weight loss interventions in PwO are well known: (i) significant weight loss induced by caloric restriction and bariatric surgery results in accelerated bone turnover and bone loss, and (ii) unlike caloric restriction interventions, PwO experience a substantial deterioration in bone microarchitecture and strength associated with an increased risk of fracture after bariatric surgery especially malabsorptive procedures. Liraglutide seems to have a positive effect on bone material properties despite significant weight loss in several rodent models. However, most of positive effects on bone mineral density and microarchitecture were observed at concentration much higher than approved for obesity care in humans. No data have been reported in preclinical models with semaglutide. The current evidence of the effects of GLP-1Ra on bone health in PwO is limited. Indeed, studies on the use of GLP-1Ra mostly included patients with diabetes who were administered a dose used in this condition, did not have adequate bone parameters as primary endpoints, and had short follow-up periods. Further studies are needed to investigate the bone impact of GLP-1Ra, dual- and triple-receptor agonists for GLP-1, glucose-dependent insulin releasing polypeptide (GIP), and glucagon in PwO.

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Narrative Review of Effects of Glucagon-Like Peptide-1 Receptor Agonists on Bone Health in People Living with Obesity

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